Health trajectories of children with severe obesity attending a weight management program.

PURPOSE: The objective of the present study is to examine physical and mental health trajectories of change in youth with severe obesity attending a tertiary care weight management program. It was predicted that younger children would show favourable changes in body mass index (BMI), markers of cardiovascular health, quality of life, and mental health. METHODS: This 2-year longitudinal study examined health trajectories of children referred to a weight management program at a Canadian paediatric tertiary care centre from November 2010 to December 2013. Participants were 209 of 217 consecutive referred paediatric patients (families) aged 3 to 17 years who met criteria for severe obesity and consented to participate. To maximize generalizability of results, there were no exclusion criteria. Primary outcomes were children's quality of life and BMI. Secondary outcomes included anxiety, depression, and non-high-density lipoprotein cholesterol levels. RESULTS: The findings suggest an improvement in mental health, quality of life, and cardiometabolic health of children and adolescents of all ages over the 2 years of programming. These positive findings were consistent across gender, age, and distance to the program. BMI trajectory changes varied across age cohorts such that younger children showed more favourable outcomes. The retention rate over the 2 years was high at 82.9%. CONCLUSIONS: This is the first study to show improvements in both physical and mental health outcomes beyond 1 year in a tertiary care setting with a high-risk population of children and youth with severe obesity. Findings highlight the need to examine both mental and physical health outcomes beyond 1 year.

Evaluation of a Pediatric Obesity Management Toolkit for Health Care Professionals: A Quasi-Experimental Study.

Health care professionals (HCPs) play a critical role in helping to address weight-related issues with pediatric patients, yet often feel ill-equipped to discuss/manage this complex and sensitive health issue. Using the five As ("Ask, Assess, Advise, Agree, and Assist") of Pediatric Obesity Management, we created a series of educational videos and evaluated the content, quality (acceptability, engagement), and impact of these videos on HCPs' self-efficacy, knowledge, and change in practice when addressing weight-related issues with pediatric patients and their families using questionnaires. HCPs (n = 65) participated in a baseline assessment and 4-6 month follow-up (n = 54). Knowledge and self-efficacy increased post-video for the majority of participants. At follow-up, most HCPs reported a change in their practice attributable to viewing the videos, and their self-efficacy ratings improved over time for the majority of questions asked. Most participants rated aspects of each of the videos highly. Preliminary findings suggest that an evidence-based educational toolkit of videos, based on the 5As framework, may lead to changes in self-reported behaviors among HCPs, and sustained improvements in their self-efficacy in addressing weight-related topics with children and their families. (Clinical Trial Number NCT04126291).